Conflicts of Interest concerns about three members of WHO’s new High-level Commission on NCDs

In response to the call for comments on WHO’s proposals for an Independent Global High-level Commission on NCDs I sent the comments below, outlining our serious concerns about the appropriateness of three of the proposed Commissioners, who will have an ‘advisory’ role: Arnaud Bernaert, World Economic Forum; Dr Sania Nishtar and Katie Dain of the NCD Alliance.

Since our concerns were not taken up we are asking further questions about the “DUE DILIGENCE” criteria used to determine who is accepted,

I am writing on behalf of Baby Milk Action/IBFAN UK regarding our concerns about three of the proposed Commissioners for WHO’s Independent Global High-level Commission on NCDs.

As one of WHO’s longest-standing public interest partners, IBFAN places great value on WHO’s Core constitutional norm-setting functions and its independence, integrity and trustworthiness. Weith this in mind we respectfully urge WHO to ensure that the appointments and terms of reference for this Commission safeguard WHO’s core constitutional functions:

as the directing and coordinating authority in international health work (Art.2a);

its mandate to propose conventions, agreements and regulations (Art.2k);

Our comments relate to the fact that the Commission has an advisory role.

Arnaud Bernaert: IBFAN’s concern relates to Mr Bernaert’s role as Senior Director of Global Health and Healthcare of the World Economic Forum (WEF). WEF members include some of the worlds largest corporations ­whose marketing practices are known to damage health and the environment, and who are actively involved in deforestation, mono-cropping, land and sea grabbing and risky technologies.

WEF and its members are not benign bystanders in relation to UN policies. Indeed WEF’s Global Redesign Initiative, launched in 2010, proposes that issues are taken off the agenda of the UN system to be addressed instead by ‘plurilateral, often multi-stakeholder, coalitions of the willing and the able.’ The GRI envisages a world managed by a coalition of multinational corporations, nation states (including through the UN System) and select civil society organisations.

Since 2009 when WHO established the short-lived NCDNet, IBFAN has opposed proposals that WEF should have any advisory role in relation to WHO. While WEF or its members may act as multipliers/disseminators of WHO recommendations – and certainly have access to vast amounts of information that policy makers might find useful – we believe that WHO would be reneging on its constitutional mandate and would set a bad model for Member States, if it was to go further and to allow a representative of WEF to have the advisory role of Commissioner on any public health policy matter. Throughout the many debates about the role of Non State Actors, Member States have given consistent reassurances that WHO’s policy-setting functions would be protected from commercial influence. It should be among WHO’s highest priorities to ensure that this is the case.

WHO Draft Global Programme of Work (Rev 2)Para 78: “At the same time WHO sets norms and standards which differentiates it from these other actors in global health. WHO’s Framework of Engagement with Non-State Actors provides the guidance needed to engage in partnerships with all types of non-State actors while maintaining the Organization’s integrity and independence from interests detrimental to health”. 111. “… At the same time, WHO must protect its work from conflict of interest, reputational risks, and undue influence.”FENSA Para 4: “… This requires a robust framework that enables engagement and serves also as an instrument to identify the risks, balancing them against the expected benefits, while protecting and preserving WHO’s integrity, reputation and public health mandate.”

An additional concern is Mr Berbaert’s former role (until 2014) as Senior Vice-President of Philips Healthcare in charge of global strategy, business development. Philips manufactures medical equipment and a range of other products, including baby feeding bottles that are covered by the scope of International Code of Marketing of Breastmilk Substitutes and subsequent relevant WHA Resolutions. Throughout Mr Berbaert’s time at Philips, the company marketed these products in ways that are in violation of that Code. Philips currently claims to be the “#1 brand recommended by mums worldwide”[1]

Dr Sania Nishtar, Former Federal Minister, Pakistan, Founding President, Heartfile. While we acknowledge and appreciate the areas where our advocacy aims are in line, our concern about Dr Nishtar’s appointment as Co-Chair of the Commission relates to an article published in the medical journal, the Lancet (Vol 390 October 21, 2017): The NCDs Cooperative: a call to action. In this article Dr Nishtar called for the setting up of an “international multistakeholder agency called The NCDs Cooperative…” stating that “WHO’s mandate and governance structure may preclude it from leading and hosting a multisectoral public–private partnership.” The clear implication is that WHO’s conflict of interest safeguards – inadequate as we believe them to be – are an obstacle to progress that should be bypassed. Surely the role of all the Commissioners should be to uphold WHO policy and help WHO make recommendations that are fully in line?

Sadly Dr Nishtar’s article failed to provide evidence of the efficacy of public private partnerships (PPPs) or highlight their known risks in relation to NCD prevention and other threats to global health. It is worth noting that since 2003 OECD Guidelines ‘Managing conflict of interest in the public service’ have identified PPPs and hybrid entities as particular “at risk areas” for conflicts of interest.[2]

We hope that the new Commission will help governments remain in the drivers seat when tackling NCDs. It could encourage them to have clear assessments of their national situations based on hard data, with goals, a clear strategy, and careful consideration of whether and what role private sector should play in its implementation. Pretending that it is easy or feasible to find ‘Common ground’ with corporations – especially on regulatory issues – will not be helpful.

Katie Dain, CEO NCD Alliance, Co-Chair, WHO Civil Society Working Group for the third High-level Meeting on NCDs. We are concerned about the proposal to have the NCD Alliance represent civil society on this Commission and Co-chair the Civil Society Working Group. Our concern relates to the funding of the NCD Alliance. The NCDa was established by a US$1 million grant from the world’s largest medical technology company (Medtronics) and according to the most recent available evidence, we understand that nearly 50% of its funding is derived from other pharmaceutical companies (e.g., Novo Nordisck, Sanofi, Lilly, and Merck). All these companies are directly subject to WHO Guidance to national governments. They all have a clear financial incentive to influence WHO policies, to favour ‘treatment’ rather than ‘prevention’ while undermining efforts to bring in regulations that affect their bottom line. NCDA’s non-industry members include the World Heart Federation and the International Diabetes Federation, entities that are also substantially funded by pharmaceutical companies.

For all the above reasons, and while we acknowledge and appreciate the areas where our advocacy aims are currently in line, we cannot support the proposal that NCDa should represent Civil Society on this Commission. Like many public interest NGOs, we have made the decision to refuse corporate funding and our advocacy in relation to public private partnerships and the involvement of corporations differs to that of NCDa in several key areas.